Provider Demographics
NPI:1891076113
Name:BENSON CHIROPRACTIC INC
Entity Type:Organization
Organization Name:BENSON CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-372-4204
Mailing Address - Street 1:2150 302ND AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627-9708
Mailing Address - Country:US
Mailing Address - Phone:319-372-4204
Mailing Address - Fax:319-376-1204
Practice Address - Street 1:2150 302ND AVE
Practice Address - Street 2:
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627-9708
Practice Address - Country:US
Practice Address - Phone:319-372-4204
Practice Address - Fax:319-376-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO5520111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UO1935Medicare UPIN